Ellyete de Oliveira Canella

Conduta das funcionárias de um hospital na adesão ao programa de prevenção do câncer de mama

OBJECTIVE: To evaluate the adherence of a hospital female personnel to a program for breast cancer prevention by means of mammography. MATERIALS AND METHODS: The study was developed with 91 female workers evaluated by means of a questionnaire and follow-up of the periodicity of mammographic studies in the period from 2000 to 2009. RESULTS: A total of 247 mammography studies were performed. Compliance with the periodicity schedule was informed by 48 of the participants, 12.6% of them by medical request, 47.9% because they were aware of the relevance of such study, 4.1% because of previous family history of cancer, and 35.4% as a clinical routine. Forty-three participants did not comply with the periodicity schedule, 37.3% of them because they had not a medical request, 20.9% because they could not have it done through the Sistema Unico de Saude (Brazilian Unified Health System), 18.6% for fear, and 23.2% due to unawareness about the relevance of such an examination. CONCLUSION: The participation in the program was low. The adherence to the program was poor in the hospital because of the unawareness about breast cancer prevention.

Percutaneous biopsy in radiological imaging of the breast

The article “Diagnostic underestimation of atypical hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution” (1) , published in the previous issue of Radiologia Brasileira, was produced at a referral teaching institution and reflects the level of responsibility required in order to perform invasive procedures in clinical practice. In 1989, Dr. Parker started performing percutaneous biopsy, using a core needle and an automatic deployment device, for the diagnosis of nonpalpable breast lesions, the detection of which was becoming increasingly more frequent after the advent of high-resolution mammography. In their first study of the topic, published in 1990, Parker et al. compared the performance of core biopsy with that of surgical biopsy, concluding that core biopsy represents a reliable, rapid, and affordable alternative that is well-tolerated by patients with minimum complications and a low risk of parenchymal scarring (2) . In 1995, Dr. Parker developed the vacuum-assisted breast biopsy technique (using the Mammotome ® equipment), to improve the accuracy of biopsies of microcalcifications in adipose breast tissue (3) . Core and vacuum-assisted biopsies were initially greeted with skepticism and even rejected by some medical professionals. Image-guided percutaneous biopsies, however, would bring changes to the field and gain broad acceptance for use in

Auditoria em centro de diagnóstico mamário para detecção precoce de câncer de mama

OBJETIVO: Este trabalho apresenta o modelo de auditoria nos resultados das mamografias do Centro de Diagnostico Mamario da Santa Casa da Misericordia do Rio de Janeiro. MATERIAIS E METODOS: No periodo de maio de 1997 a setembro de 1998, foram realizadas 2.000 mamografias, sendo 1.570 em mulheres assintomaticas, cujos resultados foram objeto da auditoria. RESULTADOS: As mamografias das 1.570 mulheres assintomaticas foram classificadas em: categoria 1 - 1.362 casos; categoria 2 - 9 casos; categoria 3 - 95 casos; categoria 4 - 24 casos; categoria 5 - 6 casos; categoria 0 - 74 casos. Dos 199 exames anormais (categorias 0, 3, 4 e 5), foram acompanhadas 107 mulheres (54%) e perdidas 92 mulheres (46%). Os 107 casos incluidos no trabalho tiveram a seguinte classificacao: categoria 3 - 48 casos; categoria 4 - 18 casos; categoria 5 - 4 casos; categoria 0 - 37 casos. Dos 48 casos categoria 3, nenhum caso de câncer foi encontrado; dos 18 casos categoria 4, dois casos de câncer foram encontrados; dos quatro casos categoria 5, todos foram diagnosticados câncer; dos 37 casos categoria 0, um caso de câncer foi encontrado. Os valores de auditoria obtidos foram os seguintes: valor preditivo positivo (baseado no exame com resultado anormal) - 11%; valor preditivo positivo (quando houve recomendacao de biopsia) - 31%. A taxa de deteccao de câncer, em 1.570 mulheres, foi de sete casos; a sensibilidade foi de 100%; a especificidade foi de 96%; a taxa de reconvocacao foi de 4,7%. CONCLUSAO: Todos os resultados obtidos reproduzem os resultados recomendados na literatura.

Breast Cancer Screening: Updated Recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

1Coordinator of the National Mammography Commission, Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil 2Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil 3Member of the National Mammography Commission, Representative of the Sociedade Brasileira de Mastologia (SBM), São Paulo, SP, Brazil 4Member of the National Mammography Commission, Representative of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), Rio de Janeiro, RJ, Brazil

Fat necrosis in the breast after reconstruction with transverse rectus abdominis myocutaneous flap: MRI features.

Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM) is a frequently used technique following mastectomy [1,2]. Fat necrosis is a commonly seen postoperative change in the reconstructed breast [3], often palpable and sometimes difficult to distinguish from local recurrence, especially in the clinical exam. Fat necrosis has different forms of presentation [1], which are best identified and characterized with magnetic ressonance imaging (MRI). The purpose of this study is to describe different MRI features of fat necrosis after TRAM flap reconstruction.

Carcinoma medular da mama: correlação anátomo-radiológica

OBJECTIVE: To evaluate radiological findings in patients submitted to surgical treatment for medullary breast cancer at Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil, correlating them with histological results. MATERIALS AND METHODS: A retrospective descriptive study was developed with patients submitted to surgery at INCA, in the period from January 1997 to December 2006, for identifying the presence of medullary breast carcinoma and analyzing radiological findings. RESULTS: Among 21,287 patients diagnosed with carcinoma, 76 (0.357%) had typical medullary breast carcinoma. The age range of these patients was 32-81 years (mean = 59.1 years). Mammography demonstrated lesions in 19 of these patients, 17 (89.5%) of them with masses, and 2 with focal asymmetry. Among the patients with masses, 15 (88.1%) presented with high density and 2 (11.9%) with isodensity. Twelve patients presented sonographic findings, 11 (91.6%) of them with hypoechoic masses, and one with an anechoic mass with areas of cystic degeneration. CONCLUSION: Nodular mass was the predominant radiological finding (89.5%), 88.1% of them corresponding to masses with high density and circumscribed margins. Despite the radiological characteristics of benignity, a solid, fast-growing, highly dense mass with circumscribed margins should be further investigated to confirm the diagnosis.

Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

Objective To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations. Materials and methods We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts. Recommendations Annual mammography screening is recommended for women 40-74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.